Value of Intraoperative Sonography in Pancreatic Surgery

Abstract

The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease.1–8 Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care—the surgeon's scalpel—can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures.

Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies

“…During the operation, there are a number of procedures that are frequently used to localize the panNET which include the use of intraoperative ultrasound (IOUS) [186] in the case of gastrinomas, which are frequently in the duodenum, the use of duodenotomy and transillumination of the duodenum, as well as mobilization of the duodenum [45,128,187]; and in some cases, radio-guided-surgery [188,189]. IOUS is particularly useful for intrapancreatic lesions allowing detection of small lesions (as small as 2 mm), defining their relationship to the pancreatic duct, also allows detection of hepatic metastases [186,190], however IOUS is not as sensitive for duodenal NETs such as duodenal gastrinomas. Duodenal gastrinomas in patients with ZES (60–90% of all patients) are frequently small, many be multiple (especially in MEN1/ZES) and difficult to find, thus requiring a duodenotomy with or without transillumination of the duodenum to find them [16,45,47,187,191].…”

“…Radioguided surgery in a number of patients with panNETs and other NETs has been reported in a few studies, generally involving small number of patients [186,188,189,192–194]. These include primarily the use of various hand-held detectors after the prior administration of radiolabeled somatostatin analogues, which in some cases identified lesions not otherwise evident.…”

“…These include primarily the use of various hand-held detectors after the prior administration of radiolabeled somatostatin analogues, which in some cases identified lesions not otherwise evident. [186,188,189,192–194]. This approach has been used successful after 18F-DOPA in patients with medullary thyroid cancer to find additional metastases [195].…”

Time to update the American Association for the Surgery of Trauma pancreas injury grading lexicon?

“…A final and more contemporary option remains, which is surgeon-performed intraoperative ultrasound. This imaging modality has the benefit of real-time interpretation in experienced hands, as well as operative simplicity and rapid image acquisition in the context of demanding competing injuries 17 . This intraoperative ultrasound technique is a routine skill within all modern hepatopancreatobiliary fellowship training 18 .…”

Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation

“…The sensitivity of intraoperative ultrasound (IOUS) in the detection of small p-NETs is similar to that of EUS, but if combined with direct palpation, its sensitivity rises to 97% [ 62 ].…”